Are we afraid to move

Does fear of moving change the way in which we move? This is a common question from students. This is a recent article describing the relationship between fear of movement and movement patterns. Read it through and see how it develops your understanding of this relationship.

Trunk motor control deficits in acute and subacute low back pain are not associated with pain or fear of movement

Won, Sung, 2015

Background context

A subgroup of patients with acute to subacute low back pain (LBP) presenting with trunk movement control deficits, pain provocation with segmental testing, and segmental hypermobility have been clinically identified as having movement coordination impairments (MCIs) of the trunk.

Purpose

To identify trunk motor control (postural control and movement precision) impairments in a subgroup of patients with acute to subacute LBP who have been clinically identified to have MCIs and determine association of these impairments with pain and fear of movement.

Patient sample

Thirty-three patients with acute to subacute LBP presenting with trunk MCIs and 33 healthy controls matched with gender, age, and body mass index were identified.

Outcome measures

Self-report measures included Numeric Pain Rating Scale, Oswestry Disability Index Questionnaire, and Fear-Avoidance Beliefs Questionnaire and physiologic measures included postural control and movement precision.

Methods

Center-of-pressure movement was measured while subjects attempted to volitionally control trunk posture and movement while sitting on a platform with a hemisphere mounted underneath. Postural control was tested using eyes-open and -closed balance protocols. Movement precision was tested with a dynamic control test requiring movement of the center of pressure along a discrete path. Group trunk motor control performance was compared with analysis of variance and t test. Performance association with pain and fear of movement were assessed with Pearson correlations.

Results

Patients’ postural control in the eyes-closed condition (p=.02) and movement precision (p=.04) were significantly impaired compared with healthy controls, with moderate-to-large group difference effect sizes. These trunk motor control impairments were not significantly associated with the patients self-reported pain characteristics and fear of movement.

Conclusions

Patients with clinical identification of trunk MCIs demonstrated decreased trunk motor control, suggesting that impairments in proprioception, motor output, or central processing occur early in the back pain episode. This information may help to guide interventions to address these specific limitations, improving delivery of care.

This paper interrogates the concept that fear of movement changes how individuals move. It suggests that fear of movement and movement patterns are not related. Hence the movement pattern clinicians observe in their patients with kinesiophobia maybe due to reasons other than their fear of movement.

  • http://dx.doi.org/10.1016/j.spinee.2015.04.010